Methods and compositions for activated protein c with reduced anticoagulant properties

ABSTRACT

This invention relates to a novel form of protein C or activated protein C. More specifically, the invention is directed to a variant of protein C that is activated at a higher rate than wild-type or other variants and produces an activated protein C with reduced anticoagulant properties while retaining the protective anti-inflammatory and anti-apoptotic properties of wild-type activated protein C. This novel APC variant will be beneficial for treating inflammatory and apoptotic disorders with a reduced risk for bleeding.

RELATED APPLICATIONS

This patent application is a divisional application of U.S. patentapplication Ser. No. 11/848,080 filed Aug. 30, 2007 allowed, and claimsbenefit of priority to patent application U.S. provisional patentapplication Ser. No. 60/841,384, filed Aug. 31, 2006. All documentsabove are incorporated herein by reference in their entirety.

GOVERNMENT SUPPORT CLAUSE

The work disclosed herein was supported by the National Heart, Lung, andBlood Institute of the National Institute of Health grant number HL68571. The U.S. Government has certain rights in this invention.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates generally to compositions and methods involved inthe therapeutic use of protein C. Specifically, the invention isdirected to a novel protein C that is activated by free thrombin at anincreased rate, and upon activation, exhibits the protectiveanti-inflammatory and anti-apoptotic properties of wild-type activatedprotein C, but lacks the anti-coagulant properties responsible forexcessive bleeding in some individuals. This novel protein C and itsactivated derivative may be useful for treating diseases which involveinflammation or apoptosis, such as severe sepsis.

2. Description of the Related Art

Activated protein C (APC), exhibits anti-inflammatory, cytoprotective,and potent anti-coagulant activity properties. In addition, recombinantactivated protein C (APC) has been approved as a drug for treatingsevere sepsis, and has reduced mortality in these patients (See Bernardet al. (2001) N Eng J. Med.; 344:699-709). Studies have also shown thatAPC may protect the endothelial cells of the brain from damage caused byischemic stroke (Cheng et al. (2003) Nature Med.; 9:338-342):

There is growing evidence that the protective effects associated withAPC when administered therapeutically are separate from itsanti-coagulant effect, and that these protective effects are attributedto cell signaling by APC in the endothelium (Taylor et al. (1987) J ClinInvest. 1987; 79:918-925; Feistritzer et al. (2005) Blood;105:3178-3184; Mosnier et al. (2003) Biochem J.; 373:65-70; Cheng et al.(2003) Nature Med.; 9:338-342; Guo et al. (2004) 41:563-572). Anincreased incidence of bleeding remains a major drawback of APCtreatment (Bernard et al. (2001) N Eng J. Med.; 344:699-709). This riskof bleeding prevents medical practitioners from fully utilizing APCtherapy. Practitioners also require more treatment options, for example,a zymogen form of protein C that is more efficiently activated,particularly under inflammatory conditions. To our knowledge, theseproblems have not been solved. Protein C is activated inefficientlyindependent of the thrombin TM complex, and APC continues to include ahigh risk of bleeding. Therefore, there is a need for a protein C thatis readily activated by free thrombin, and an APC with diminishedanti-coagulant activity and normal cytoprotective properties.

SUMMARY OF THE INVENTION

The present invention relates to a variant of protein C and activatedprotein C whereby two cysteine residues are substituted for specificamino acids allowing the formation an intra-chain disulfide bond tocross-link the composition such that it possesses a new set ofbiological properties. The novel protein C is readily activated by freethrombin, and once activated exhibits cytoprotective properties withoutthe increased risk of bleeding associated with the wild type activatedprotein C.

One embodiment the invention is drawn to a novel form of protein C,whereby one of amino acids 261-266 of SEQ ID NO:1 are cross-linked toone of amino acids 278-288 of SEQ ID NO:1. This cross-linking may be theresult of a cysteine, substituted for an amino acid residue in each ofthese polypeptides sequences, whereby the substituted cysteines form adisulfide bond. This cross-linked protein C is distinguished from thewild type by exhibiting rapid activation by free thrombin.

Related to the novel form of protein C is an activated form of thevariant whereby one of amino acids 261 to 266 of SEQ ID NO:1 arecross-linked to one of amino acids 278 to 288 of SEQ ID NO:1 and theactivation peptide residues 200-211 of SEQ ID NO:1 is cleaved. Thiscross-linking may be the result of a cysteine, substituted for an aminoacid residue in each of these polypeptides sequences, whereby thesubstituted cysteines form a disulfide bond. The activated form isdistinguished from wild type by exhibiting cytoprotective properties andreduced anticoagulant activity.

In another embodiment, the invention is drawn to a method ofmanufacturing a cross-linked protein C, comprising the steps of (a)constructing an appropriate cDNA containing expression vector and (b)expressing the vector in a host cell.

Another embodiment relates to a cross-linked protein C in apharmaceutically acceptable formulation for administration to a patient.

Another embodiment relates to a cross-linked activated protein C in apharmaceutically acceptable formulation for administration to a patient.

Another embodiment relates to a method of treating an inflammatorydisease such as sepsis, severe sepsis, or septic shock by administeringcross-linked protein C or cross-linked activated protein C to thepatient. Cross-linked protein C or cross-linked activated protein C mayalso be administered to treat a neurological disorder in a patient, ofwhich ischemic stroke, Alzheimer's disease, Huntington disease, multiplesclerosis, ischemia, epilepsy, amyotrophic lateral sclerosis areexamples.

REFERENCE TO COLOR FIGURES

The application file contains at least one figure executed in color.Copies of this patent application publication with color photographswill be provided by the Office upon request and payment of the necessaryfee.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 illustrates the crystal structure of the catalytic domain of APCand positions of cysteine substitutions. The three-dimensional positionsof Arg-67 (blue) and Asp-82 (red) on two anti-parallel beta structuresof APC are shown. The catalytic residue Ser-195 (green) is also shown.The coordinates (Protein Data Bank entry 1AUT) were used to prepare thefigure (Rezaie et al. (1994) J Biol Chem.; 269:3151-3154).

FIG. 2 illustrates protein C activation by thrombin. The activation ofeither wild-type () or Cys-67-82 protein C (cross-linked protein C) (◯)(1 μM each) was monitored by thrombin (5-50 nM) in TBS/Ca2+ at roomtemperature. The rate of APC generation was determined by an amidolyticactivity assay following thrombin neutralization by antithrombin. Theactivation rate was 0.002 nM and 0.16 nM APC/nM thrombin for wild-typeand mutant protein C, respectively.

FIG. 3 illustrates the comparison of the anti-coagulant activity ofwild-type and Cys-67-82 APC. (A) The rate of fVa degradation by eitherwild-type (◯) or Cys-67-82 APC () was measured by a fVa-mediatedthrombin generation assay. (B) the anti-coagulant activity of eitherwild-type (◯) or Cys-67-82 APC () was measured in an activated partialthromboplastin time (APTT) assay.

FIG. 4 illustrates thrombin-induced permeability in EA.hy926 cells. (A)The concentration of APC (◯ wild-type APC,  Cys-67-82 APC) dependenceof the inhibition of thrombin-induced permeability was monitored fromthe flux of Evans blue-bound albumin across confluent EA.hy926 cells.(B) Permeability was quantitated (*p<0.005) in the absence and presenceof function-blocking antibodies to either EPCR or PAR-1 (H-111). S-19 isa non-function-blocking antibody to PAR-1.

FIG. 5 illustrates the anti-apoptotic activity of APC in thestaurosporine-induced apoptosis assay. (A) Confluent monolayers ofEA.hy926 cells were treated with APC derivatives (10 nM) for 24 hfollowed by induction of apoptosis with staurosporine (STS=5 μM) for 4h. The cells were fixed with paraformaldehyde and incubated with theTUNEL reaction mixture followed by Hoechst 33342 to stain the apoptoticcells (green) and the total number of nuclei (blue), respectively. (B)The number of apoptotic cells was expressed as the percentage ofTUNEL-positive cells of the total number of nuclei (*p<0.001). (C)Western-blot analysis of the total cellular proteins developed with theindicated antibodies using standard methods.

FIG. 6 illustrates the anti-apoptotic activity of APC derivatives in theTNF-α-induced apoptosis assay. Conditions are the same as in FIG. 5except that TNF-α (10 ng/mL) was used to induce apoptosis (*p<0.001).

FIG. 7 illustrates the TNF-α-induced adhesion and transendothelialmigration of neutrophils in EA.hy926 cells. (A) TNF-α-mediated (10ng/mL) expression of adhesion molecules in EA.hy926 cells was analyzedafter treating monolayers with protein C (PC), APC, or Cys-67-82 APC (20nM each) in the absence and presence of function-blocking antibodies toEPCR and PAR-1 (H-111) or non-blocking antibody to PAR-1 (S-19). (B)TNF-α-mediated adherence of neutrophils to EA.hy926 monolayers wasanalyzed after treating monolayers with protein C (PC), APC S195A, APC,or Cys-67-82 APC in the absence and presence of the same antibodies inpanel A. (C) The same as B except that transendothelial migration ofneutrophils was analyzed as described under “Materials and Methods forExamples”. *p<0.001 in all three panels.

FIG. 8 illustrates the anticoagulant effects of WT APC and Cys-67-82 APC(Cys APC) in the APTT in baboon (A) and mouse (B) plasma. Compared towild-type APC Cys-67-82 APC was seen to have potent anti-coagulanteffects in both baboon and mouse plasma.

DETAILED DESCRIPTION OF THE INVENTION I. Cross-Linked Protein C andCross-Linked Activated Protein C

The present invention relates to a method of forming cross-linkedprotein C. The invention also relates to the cross-linked protein C,which when activated forms a cross-linked activated protein C, thatexhibits the same cytoprotection as wild type activated protein C exceptthe newly formed cross-linked activated protein C does not haveanticoagulant properties.

Cross-linked protein C was produced by the substitution of specificamino acids of the wild type human protein C polypeptide to alterfunctional properties such as activation by thrombin andanticoagulation, while leaving other properties such as cytoprotectionintact. Therefore the following is a detailed description of thestructure and function of the modified human protein C polypeptide thatcomprises cross-linked protein C and cross-linked activated protein C.

A. Protein C and Activated Protein C i Post-Translational Modification

Wild type human protein C is the inactive zymogen form of a vitaminK-dependent plasma serine protease. Wild type protein C, in vivo, or assecreted by a eukaryotic cell in culture exists in the form of adisulfide-linked two chain molecule. It is transcribed as a singlepolypeptide (see SEQ ID NO:1), which then undergoes post-transitionalmodification. Modifications include removal of a signal peptide sequence(amino acids 1-42), and removal of a dipeptide sequence (amino acids198-199), which produces two polypeptides referred to as the light (˜25kD) (amino acids 43-197) and heavy chains (˜41 kD) (amino acids200-461). Variations in molecular weight occur due to differences inglycosylation, which is also a post-translational modification. Thelight chain contains a region of gamma-carboxyglutamic acid, which isrequired for membrane binding and is dependent on Ca²⁺. The heavy chaincontains the serine protease domain, which also contains a Ca²⁺ bindingsite described in detail below. The heavy chain also contains theactivation peptide. Activation of protein C to activated protein C takesplace in vivo by removable of this activation peptide (amino acids200-211) by thrombin. A disulfide bond at cysteine 183 and cysteine 319connects the heavy and light chains. (Plutzky et al., (1986) Proc. Natl.Acad. Sci. (USA) 83, 546-550)

ii Activation and Anticoagulation Activity

Protein C circulates as an inactive zymogen. Activation of protein C toactivated protein C takes place by proteolytic removal of the activationpeptide (amino acids 200-211, see SEQ ID NO:1) from the heavy chain.Protein C is activated on the surface of endothelial cells by athrombin-thrombomodulin (thrombin-TM) complex, which is also acceleratedby the endothelial protein C receptor (EPCR). This is believed to takeplace by co-locating protein C with the thrombin-TM complex on theendothelial cell surface (Stearns-Kurosawa et al. (1996) Proc Natl AcadSci. (USA); 93:10212-10216). After activation, activated protein Cdown-regulates the clotting cascade via a feedback loop mechanism(Stenflo J. (1984) Thromb Hemost. 10:109-121; Esmon C T. (1993) Thromb.Haemost. 70:1-5). Once protein C is activated it may dissociate fromEPCR, and form a complex with the vitamin K-dependent protein cofactor,protein S. This complex will shut down the generation of thrombinderived from the cofactor effect of factors Va (fVa) and VIIIa, whichare known to be procoagulant cofactors of the prothrombinase andintrinsic Xase complexes, respectively (4-6).

iii Anti-Inflammatory and Cytoprotective Properties

In addition to providing anti-coagulant activity, APC hasanti-inflammatory and anti-apoptotic proprieties. When APC is associatedwith EPCR, it elicits protective signaling responses in endothelialcells (Taylor et al. (1.987) J Clin Invest. 1987; 79:918-925; Taylor etal. (2000) Blood; 95:1680-1686; Joyce et al. (2001) J Biol Chem.;276:11199-11203; Ruf et al. (2003) J Thromb Haemost. 1:1495-1503;Mosnier et al. (2004) Blood. 104:1740-1744; Finigan et al. (2005) J BiolChem.; 280:17286-17293). These protective signals may account for thebeneficial effects associated with APC when used as an anti-inflammatoryagent for treating severe sepsis patients (Bernard et al. (2001) N Eng JMed.; 344:699-709). The mechanisms of the anti-inflammatory andcytoprotective effects of APC are not well understood, however, it isbelieved that an APC/EPCR complex cleaves protease-activated receptor-1(PAR-1) to initiate protective signaling events in endothelial cells(Ruf et al. (2003) J Thromb Haemost. 1:1495-1503; Mosnier et al. (2004)Blood. 104:1740-1744). PAR-1 cleavage by APC may also be required forthe inhibition of apoptosis in human brain endothelial cells induced byhypoxia (Cheng et al. (2003) Nature Med.; 9:338-342).

B. Cross-Linked Protein C

The present invention alters the above-described protein C to produce across-linked protein C which is activated rapidly by free thrombin.Also, cross-linked protein C in its activated form demonstrates thecytoprotective properties of wild-type APC without the anti-coagulantproperties. This is achieved by engineering a disulfide bond to form across-link between two anti-parallel β-sheets of the heavy chainpolypeptide of human protein C. Specifically, amino acid residues atposition 264 and also position 279 of wild type protein C (SEQ ID NO:1)are each substituted with cysteines, to produce a novel polypeptide (SEQID NO:2) (Bae et al. (2007) J Biol Chem.; 282: No. 12: 9251-9259). Thepresence of cysteines in these positions will allow the formation of anintra-chain disulfide bond post-translationally, thereby forming across-link between these two amino acids within the anti-parallel13-sheets of residues 261-266 and 278-288 of the protein C heavy chain(see FIG. 1). Similarly, the presence of cystines or anothercross-linking agent, installed at one or more of these positions, withinor near these anti-parallel (3-sheets would produce a similar result.Between these anti-parallel β-sheets is the Ca²⁺ binding 70-80 loop(CHT). While not agreeing to be bound by theory, one hypothesis is thatthe binding of Ca²⁺ to the 70-80 loop of protein C is associated with aconformational change in the zymogen that is optimal for interactionwith thrombin in the presence of TM but inhibitory for interaction inthe absence of the cofactor (Yang et al. (2006) Proc Natl Acad Sci.(USA); 103:879-884). By cross-linking two anti-parallel/3-sheets, the70-80 calcium binding loop becomes stabilized and no longer binds Ca²⁺.The engineered disulfide bond also stabilizes a Na⁺ binding site in thehigh affinity state. These Ca²⁺ and Na⁺ binding sites modulateactivation of protein C and may be necessary for the amidolytic activityand proteolytic activity demonstrated by APC, as described in detailbelow. The light chain of cross-linked protein C is not modified, and asin wild type, remains bound to the heavy chain by a single disulfidebond.

i Activation

Both wild type and cross-linked protein C may be activated byproteolytic removal of the activation peptide, amino acids 200-211 (SEQID NO:1), of the heavy chain. Wild type protein C binds to EPCR on thesurface of endothelial cells where it is activated by the thrombin-TMcomplex. Endothelial cell surface receptors EPCR and TM improve theactivation of wild type protein C by thrombin by three to four orders ofmagnitude and require Ca²⁺ (Esmon C T. (1993) Thromb. Haemost. 70:1-5;Stearns-Kurosawa et al. (1996) Proc Natl Acad Sci. (USA);93:10212-10216). The binding of Ca²⁺ to a low affinity sites in theγ-carboxyglutamic acid (Gla) domain of protein C enables protein C tointeract with EPCR on the surface of endothelial cells. This binding ofCa²⁺, improves the Km of activation by the thrombin-TM complex(Stearns-Kurosawa et al. (1996) Proc Natl Acad Sci. (USA);93:10212-10216; Oganesyan et al. (2002) J Biol Chem.; 277:24851-24854;Zhang et al. (1992) Blood; 80:942-952). The Gla domain is not altered incross-linked protein C, and this binding may still occur. In addition,there exists another Ca²⁺ binding site that is required for thethrombin-TM complex to activate wild type protein C at a physiologicallyrelevant rate on the endothelial cell surface (Rezaie et al. (1994) JBiol Chem.; 269:3151-3154). The position of this high affinity Ca²⁺binding site has been localized to the 70-80 loop of protein C(CHT)(Bode et al. (1989) EMBO J.; 8:3467-3475). In addition to Ca²⁺, Na⁺ alsomodulates the catalytic function of APC (He et al. (1999) J Biol Chem.;274:4970-4976; Hill et al. (1986) J Biol Chem.; 261:14991-14996). Recentstudies conducted by the inventors have indicated that these Ca²⁺, andNa⁺ binding sites are energetically linked (He et al. (1999) J BiolChem.; 274:4970-4976). The binding of Ca²⁺ as well Na⁺ produces distinctfunctional changes in the conformation of the activation peptide (Likuiet al. (2004) J Biol Chem, Vol. 279, No. 37, Issue of September 10, pp.38519-38524). While not agreeing to be bound by theory, the engineereddisulfide bond may prevent or alter changes normally caused by bindingof these ions. This may account for the enhanced activation ofcross-linked protein C by free thrombin, independent of TM in thepresence of Ca²⁺ as demonstrated in the examples.

ii Anticoagulant Activity and Anti-Inflammatory and CytoprotectiveProperties

The mechanism through which wild type protein C, once activated,functions in the anti-coagulant pathway has been extensively studied andis well understood (Walker et al. (1992) FASEB J; 6:2561-2567). Afteractivation, APC may dissociate, from EPCR and bind to protein S, whereit functions as an anticoagulant by degrading factors Va and VIIIa.Specific recognition of procoagulant factors Va and VIIIa, is determinedby the basic residues of an APC exosite (Friedrich et al. (2001) J BiolChem.; 276:23105-23108; Manithody et al. (2003) 101:4802-4807; Gale etal. (2002) J Biol Chem.; 277:28836-28840). These basic residues areclustered on three exposed surface loops referred to as 37-39 loop,60-68 loop and 70-80 loop (CHT) (Bode et al. (1989) EMBO J.;8:3467-3475). These basic residues constitute a binding site for TM inthe thrombin-TM complex. With the exception of the 60 loop, they arealso involved in recognition and subsequent degradation of factors Vaand VIIIa by APC in the anti-coagulant pathway (Friedrich et al. (2001)J Biol Chem.; 276:23105-23108; Manithody et al. (2003) Blood;101:4802-4807; Gale et al. (2002) J Biol Chem.; 277:28836-28840). Again,while not agreeing to be bound by theory, the anti-coagulant function ofAPC may require the cofactor functions of the metal ions Ca²⁺ and Na⁺both of which allosterically modulate the structure and catalyticfunction of APC (He et al. (1999) J Biol Chem.; 274:4970-4976). Such acoordinated metal ion modulation of the APC structure and function hasbeen disrupted in cross-linked APC since the engineered disulfide bondmay abolish the requirement for Ca²⁺ and, also may stabilize the Na⁺binding site of in the high affinity state. These structural changes maybe important for the anti-coagulant function but not for the protectivesignaling effects of APC. Therefore, the engineered disulfide bond hasprovided changes in structure, which have in turn cause changes inbiological function. These changes include the reduction or eliminationof anti-coagulant activity normally associated with wild-type activatedprotein C, while preserving normal cytoprotective properties. Thiselimination of anti-coagulant properties is further described anddemonstrated in the examples.

As described above (IAiii), wild type activated protein C also possessescytoprotective properties. These activities are mediated throughendothelial cell binding which takes place via the Gla domain (aminoacids 43-88 of SEQ ID NO:1). The Gla domain is not altered incross-linked protein C, and biological activity of the Gla domainremains unchanged. Therefore, similar to wild type, endothelial cellbinding via the Gla domain still occurs. Cross-linked APC mayparticipate in anti-inflammatory and anti-apoptotic activities in thesame manner as wild-type APC. These properties are further described anddemonstrated in the examples.

Therefore, by specifically engineering specific regions of the protein Cpolypeptide, while leaving other regions intact, the anti-coagulantactivity of cross-linked APC is essentially abolished, while it'santi-inflammatory and cytoprotective signaling properties remain intact.

The properties described herein for cross-linked protein C orcross-linked activated protein C may allow its use in a widertherapeutic range. For example, it may be possible for medicalpractitioners to administer greater amounts of cross-linked protein C,as the zymogen form will circulate until activated on demand byendogenous thrombin. Alternatively, or in addition to, medicalpractitioners may be able to administer higher levels of cross-linkedAPC as patients may better tolerate cross-linked APC with a reduced riskof bleeding. Also, enhanced immunogenicity is often a problem withaltered proteins, including variants of APC that are being developed astherapeutic drugs. The instant invention reduces the likelihood animmunogenic problem, since no surface residues have been altered.

Cross-linked protein C, is activated rapidly by free thrombin and onceactivated, provides anti-inflammatory and anti-apoptotic protectionwithout anticoagulation effects. This distinct set of biologicalactivities is not known in other variants of protein C. This novelcross-linked protein C and its activated derivative may be safer thanwild-type or other variants of APC for treating patients with aninflammatory or apoptotic disorder including but not limited to sepsis,severe sepsis, or septic shock. Cross-linked PC and cross-linked APC mayalso be useful for treating patients with disorders includinginflammatory bowel disease, vasculitis, renal ischemia, andpancreatitis. Cross-linked APC may also be useful for treating disordersincluding neurological disorders such as ischemic stroke, Alzheimer'sdisease, Huntington disease, multiple sclerosis, ischemia, epilepsy,amyotrophic and lateral sclerosis.

Describe herein are various properties of cross-linked protein C andcross-linked APC including activation, anti-coagulant,anti-inflammatory, anti-apoptotic and protective endothelial barrierpermeability. The methods disclosed to illustrate these properties areintended to be exemplary only and not intended to exclusively define theinstance invention. Numerous methods of measuring anti-coagulant,anti-inflammatory, anti-apoptotic and endothelial barrier permeabilityare well known in the art which may be also expected to demonstrate theproperties of cross-linked APC as disclosed herein.

C. Method of Making Cross-Linked APC

The method for making cross-linking protein C involves methodology thatare generally well known and described in detail in numerous laboratoryprotocols, one of which is Molecular Cloning 3rd edition, (2001) J. F.Sambrook and D. W. Russell, ed., Cold Spring Harbor University Press.Many modifications and variations of the present illustrative DNAsequences and plasmids are possible. For example, the degeneracy of thegenetic code allows for the substitution of nucleotides throughoutpolypeptide coding regions, as well as in the translational stop signal,without alteration of the encoded polypeptide coding sequence. Suchsubstitutable sequences can be deduced from the known amino acid or DNAsequence of human protein C and can be constructed by followingconventional synthetic or site-directed mutagenesis procedures.Synthetic methods can be carried out in substantial accordance with theprocedures of Itakura et. al., (1977) Science 198:1056 and Crea et. al.(1978) Proc. Natl. Acad. Sci, USA 75:5765. Therefore, the presentinvention is in no way limited to the DNA sequences and plasmidsspecifically exemplified.

A polynucleotide encoding human protein C polypeptide (SEQ ID NO:1) orvariants thereof, may be engineered whereby the codons representing oneor more of amino acids 261 to 266 and one or more of amino acids 278 to288 are replaced with codons for cysteine. By way of non-limitingexample, and as described below in the examples, nucleotide sequencescomplementary for a polynucleotide encoding these amino acid sequencesmay be constructed whereby codons representing amino acid 264 and aminoacid 279 are substituted by a cysteine. One of ordinary skill in the artwill understand that other codons representing other or additional aminoacids within these complementary nucleotide sequences may be replacedwith codons for cysteine to provide alternative or additional cysteinesubstitutions in a similar manner.

Examples of protein C derivatives are described by Gerlitz, et al., U.S.Pat. No. 5,453,373, and Foster, et al., U.S. Pat. No. 5,516,650, theentire teachings of which are hereby included by reference. By way ofexample primers described in the examples The polynucleotide may then beamplified using standard PCR mutagenesis methods as previously described(Rezaie et al. (1992) Journal of Biological Chemistry, vol. 267, pp.26104-26109) and herein incorporated by reference. The resulting mutantprotein C cDNA may be sub-cloned and inserted into a suitableexpressions vector using a number of commercially available restrictionsenzymes and expressed in a wide variety of eukaryotic, especiallymammalian, host cells. The polynucleotide may be operable linked to anumber of suitable control elements to provide an expressible nucleicacid molecule by using standard cloning or molecular biology techniques.See, e.g., Edge (1981) Nature 292:756; Nambair et al. (1984) Science223:1299; and Jay et al. (1984) J. Biol. Chem. 259:6311. Examples ofexpression vectors that may be effective for the expression ofcross-linked protein C include, but are not limited to, the PCDNA 3.1,EPITAG, PRCCMV2, PREP, PVAX, PCR2-TOPOTA vectors (Invitrogen, CarlsbadCalif.), PCMV-SCRIPT, PCMV-TAG, PEGSHIPERV (Stratagene, La JollaCalif.), and PTET-OFF, PTET-ON, PTRE2, PTRE2-LUC, PTK-HYG (Clontech,Palo Alto Calif.). Cross-linked protein C may be expressed using (i) aconstitutively active promoter, (e.g., from cytomegalovirus (CMV), Roussarcoma virus (RSV), SV40 virus, thymidine kinase (TK), or P.beta.actingenes), (ii) an inducible promoter (e.g., the tetracycline-regulatedpromoter (Gossen et al. (1992) Proc. Natl. Acad. Sci. USA 89:5547-5551;Gossen, M. et al. (1995) Science 268:1766-1769; Rossi et al. (1998)Curr. Opin. Biotechnol. 9:451-456), commercially available in the T-REXplasmid (Invitrogen).

Once constructed, the expression vector encoding cross-linked protein Cmay be transfected into host cells using standard gene deliveryprotocols. Methods for gene delivery are known in the art, and includebut are not limited to methods based on naked nucleic acids, calciumphosphate, electroporation, microinjection liposomes, cells, retrovirusincluding lentiviruses, adenovirus and parvoviruses includingadeno-associated virus herpes simplex virus. See, e.g., U.S. Pat. Nos.7,173,116 6,936,272, 6,818,209, and 7,232,899, which are herebyincorporated by reference. Other gene delivery mechanisms includeliposome-derived systems, artificial viral envelopes, and other systemsknown in the art (See, e.g., Rossi, J. J. (1995) Br. Med. Bull.51(1):217-225; Boado, R. J. et al. (1998) J. Pharm. Sci. 87 (Mosnier etal. (2004) Blood. 104:1740-1744):1308-1315; and Morris, M. C. et al.(1997) Nucleic Acids Res. 25(14):2730-2736)

Techniques for maintaining cells in culture to allow the expression ofrecombinant polypeptides are well known. By way of example thepolynucleotide described above may be expressed in human embryonickidney cells (HEK-293) using the RSV-PL4 expression system purificationvector system as described (Yang et al. (2006) Proc Natl Acad Sci.(USA); 103:879-884) and Yan, U.S. Pat. No. 4,981,952, both of which arehereby incorporated by reference.

Cross-linked protein C may be harvested from the culture media andpurified through any combination of protein purification techniquesknown in the art including various immuno-affinity techniques. Anantibody directed to almost any epitope on cross-linked protein C may beimmobilized to a support structure. A physiological solution containingthe molecule to be purified is exposed to the antibody whereby thetarget molecule is bound by the antibody. Methods of releasingpolypeptides from antibodies are also well known and may include changesin pH, and elution with various salts, metal ions, EDTA, EGTA, ordetergents.

Cross-linked activated protein C may be produced from cross-linkedprotein C by incubation with a proteolytic enzyme such as thrombin in aphysiological solution. By way of example a solution containingphysiological salts and cross-linked protein C may be passed over acolumn comprising thrombin immobilized to Sepharose. Alternatively,cross-linked activated protein C may be produced directly by expressionof a polynucleotide engineered to transcribe a cross-linked activatedprotein C.

Several other cross-linking methodologies may also allow for theformation of covalent bonds suitable for making cross-linked protein Cor cross-linked activated protein C. Polar or non-polar functionalgroups of amino acids may show an affinity for one another, which may beexploited and stabilized. By way of non-limiting example, tyrosinesubstitution with di-tyrosine cross-linking is described in U.S. Pat.No. 7,037,894, and is herein incorporated by reference in its entirety.Similar to the substitution of cysteine, one or more of amino acids 261to 266 of SEQ ID NO:1 and one or more of amino acids 278 to 288 of SEQID NO:1 may be substituted with tyrosine, which may later cross-linkedthrough oxidation. Once two tyrosine aromatic functional groups are inclose proximity to one another, cross-links may occur naturally, forexample as catalyzed in vivo by cytochrome c, peroxidase or bymetallo-ion complexes. Alternatively dityrosyl cross-links may be formedas described in U.S. Pat. No. 7,037,894.

Another method of cross-linking protein C or activated protein C may beto utilize immuno-cross-linking-techniques. By way of non-limitingexample, a monoclonal antibody may be raised against an epitope thatcomprises the anti-parallel β-sheets in the stabilized configuration.Fab or Fv fragments of such an antibody may be produced and incubatedwith protein C or activated protein C to stabilize the polypeptide inthe cross-linked configuration describe above. Techniques of makingmonoclonal antibodies and their fragments are well known in the art.

Alternatively, chemical cross-linking agents may be utilized. Manychemical cross-linking agents are commercially available, whichspecifically react with amino acid functional groups (Pierce Rockford,Ill.). Also, methods of treating the proteins with formamide,glutaraldehyde or UV-radiation are well known and may also be suitablefor producing cross-linked protein C or cross-linked activated proteinC. These methodologies would allow cross-linking to be performed onpurified wild type or variants of protein C or activated protein C. Inthe practice of these methods, it is routine for the artisan to varytime and concentration of protein and cross-linking agent to optimizeconditions. However, as these cross-linking methods are non-directed, anumber of non-functional molecules may be produce. Therefore thespecific activity of the cross-linked preparation may need to bedetermined after cross-linking, and the treatment regime or dosageadjusted appropriately. Specific activity may be determined, by way ofexample, using any of the in vitro assays described in the examples. Itmay be beneficial to mask function regions of protein C such as the Glaregion and the activation peptide while using non-directed chemicalcross-linkers to preserve activity.

II. Formulations and Administration of Cross-Linked APC A.Pharmaceutical Dosage Form

A pharmaceutically acceptable formulation of cross-linked PC, orcross-linked APC may be an injectable physiological solution.Cross-linked PC, and cross-linked APC are hydrophilic polypeptides andmay be administered intravenously in a sterile aqueous solution,preferable a physiological solution. A physiological solution may becomprised of isotonic balanced salts with a pH of about 7.0 to about7.5. A preferred physiological solution may comprise isotonic saline anda pH of 7.5. A single-time (bolus) injection is a possibility, as iscontinuous infusion.

The aqueous solution may further contain various salts or buffers thatare well known in the art. Injectable preparations, for example, sterileinjectable aqueous or oleaginous suspensions, may be formulatedaccording to the known art using suitable dispersing or wetting agentsand suspending agents. The sterile injectable preparation may also be asterile injectable solution or suspension in a nontoxic parenterallyacceptable diluent or solvent. Among the acceptable vehicles andsolvents that may be employed are, Ringer's solution, or isotonic sodiumchloride solution.

It is preferable to maintain the pH in a physiological range, from about6.0 to about 6.5, or about 6.5 to about 7.0, or about 7.0 to about 7.5,or about 7.5, to about 8.0, preferably about 7.0 to about 7.5. Tomaintain effective pH control, the cross-linked protein C orcross-linked activated protein C solution should contain apharmaceutically acceptable buffer.

Similarly, it is preferable to maintain the ionic strength in aphysiological range. The ionic strength is generally determined by thesalt concentration of the solution. Pharmaceutically acceptable saltstypically used to generate ionic strength include but are not limited topotassium chloride (KCl) and sodium chloride (NaCl). The preferred saltis maintained is a physiological range, by way of example sodiumchloride may be used at a concentration of 0.9 percent by weight.

Formulations developed for protein C or activated protein C are alsoknown in the art and may also be used for cross-linked protein C orcross-linked activated protein C, including those described in U.S. Pat.Nos. 6,630,137, 6,159,468, and 6,395,270 which are hereby incorporatedby reference. Cross-linked protein C or cross-linked activated protein Cmay be formulated to prepare a pharmaceutical composition comprising asthe active agent, cross-linked protein C or cross-linked activatedprotein C, and a pharmaceutically acceptable solid or carrier. Forexample, a desired formulation would be one comprising a bulking agentsuch as sucrose, a salt such as sodium chloride, a buffer such as sodiumcitrate and cross-linked protein C or cross-linked activated protein C.Formulations may be lyophilized for storage, and hydrated before use.Examples of stable lyophilized formulations include 5.0 mg/ml activatedprotein C, 30 mg/ml sucrose, 38 mg/ml NaCl and 7.56 mg/vial citrate, pH6.0; and, 20 mg/vial activated protein C, 120 mg/ml sucrose, 152 mg/vialNaCl, 30.2 mg/vial citrate, pH 6.0.

Alternatively, cross-linked PC, or cross-linked APC formulated intopharmaceutical compositions and administered by a number of differentmeans that will deliver a therapeutically effective dose. Suchcompositions may be administered, by way of example parenterally,including subcutaneously, intravenously, intramuscularly, or byintrathecal injection or infusion techniques. Additionally, a compoundmay be administered topically, including intradermally or transdermally.Also included is transmucosal administration including intranasalabsorption through the mucous membrane by inhalation spray orinsufflation. Formulation of drugs is discussed in, for example, Hoover,John E., Remington's Pharmaceutical Sciences, Mack Publishing Co.,Easton, Pa. (1975), and Liberman, H. A. and Lachman, L., Eds.,Pharmaceutical Dosage Forms, Marcel Decker, New York, N.Y. (1980).

B. Administration of Therapeutic Amounts

Cross-linked protein C and cross-linked activated protein C retain theanti-inflammatory and anti-apoptotic properties of wild-type APC. Thesebeneficial properties are responsible for the therapeutic effectsobserved when APC is used to treat inflammatory disorders in patients.Therefore, a disease or disorder that may be treated with protein C oractivated protein C, may also be treated with cross-linked protein C orcross-linked activated protein C. In addition, cross-linked PC andcross-linked APC retain these cytoprotective properties at approximatelythe same or only slightly reduced levels compared to wild typemolecules. Therefore, cross-linked protein C and cross-linked activatedprotein C may be administered in approximately the same treatmentregiments as used for PC, APC, or variants thereof. Generally, a greateramount of the zymogen (2-10 fold) may be administered for the equivalenteffective amount of the activated molecule. Furthermore, with a reducedrisk of bleeding, cross-linked PC and cross-linked APC may beadministered at higher levels than other forms of protein C or APC.

The following are examples of treatment regimes which may be used toadminister cross-linked protein C or cross-linked activated protein C totreat a condition of inflammation or apoptosis including but not limitedto sepsis, severe sepsis, septic shock, inflammatory bowel disease,vasculitis, renal ischemia, and pancreatitis ischemic stroke,Alzheimer's disease, Huntington disease, multiple sclerosis, ischemia,epilepsy, amyotrophic and lateral sclerosis. Treatment regimes foractivated protein C are described in U.S. Pat. Nos. 6,037,322,6,156,734, and 7,204,981 which are hereby incorporated by reference. Forthe reasons described in this section, cross-linked protein C orcross-linked activated protein may be administered in a similar manner.

Cross-linked protein C or cross-linked activated protein C may beadministered as a continuous infusion for about 1 to about 240 hours,about 1 to about 196 hours, or about 1 to about 144 hours, or about 1 toabout 96 hours, or about 1 to about 48 hours, or about 1 to about 24hours, or about 1 to about 12 hours, or less. Preferably, cross-linkedprotein C or cross-linked activated protein C will be administered as acontinuous infusion for about 1 to about 96 hours.

The amount of cross-linked activated protein C administered bycontinuous infusion may be from about 0.01 μg/kg/hr to about 50μg/kg/hr, about 0.1 μg/kg/hr to about 40 μg/kg/hr, or about 1 μg/kg/hrto about 30 μg/kg/hr. Preferable amounts of cross-linked activatedprotein C administered may be about 24 μg/kg/hr.

The plasma ranges obtained from the amount of cross-linked activatedprotein C administered may be about 0.02 ng/ml to about 200 ng/ml, about0.2 ng/ml to about 100 ng/ml, about 2 ng/ml to about 60 ng/ml. Preferredplasma ranges may be about 40 ng/ml to about 50 ng/ml.

Increased amounts of cross-linked protein C may be administered for theequivalent effective of cross-linked activated protein C. Therefore, theamount of cross-linked protein C administered by continuous infusion maybe from about 0.01 μg/kg/hr to about 500 μg/kg/hr, about 0.1 μg/kg/hr toabout 400 μg/kg/hr, or about 1 μg/kg/hr to about 300 μg/kg/hr.Preferable amounts of cross-linked protein C administered may be about240 μg/kg/hr.

The plasma ranges obtained from the amount of cross-linked protein Cadministered may be about 0.02 ng/ml to about 2000 ng/ml, about 0.2ng/ml to about 1000 ng/ml, about 2 ng/ml to about 600 ng/ml. Preferredplasma ranges may be about 40 ng/ml to about 500 ng/ml.

Plasma levels of cross-linked protein C or cross-linked activatedprotein may be determined as described in U.S. Pat. No. 6,037,322,hereby incorporated by reference in its entirety, or through standardimmunochemical means known in the art including Enzyme-LinkedImmunoSorbent Assay (ELISA). Cross-linked activated protein C may alsobe measured by determining amidolytic activity as described in theexamples. By way of example, plasma levels may be calculated frompretreatment and post treatment measurements.

In another alternative, cross-linked protein C or cross-linked activatedprotein C will be administered by injecting a portion (about ⅓ to about½) of the appropriate dose per hour as a bolus injection over a timefrom about 5 minutes to about 120 minutes, followed by continuousinfusion of the appropriate dose for up to about 240 hours.

In another alternative, cross-linked protein C or cross-linked activatedprotein may be administered parenterally to ensure delivery into thebloodstream in an effective form by injecting a dose of about 0.01mg/kg/day to about 10.0 mg/kg/day, B.I.D. (2 times a day), for one toabout ten days. Preferably, the protein C will be administered B.I.D.for about three days.

In yet another alternative cross-linked protein C or cross-linkedactivated protein C may be administered subcutaneously at a dose ofabout 0.01 mg/kg/day to about 10.0 mg/kg/day, to ensure a slower releaseinto the bloodstream. Formulation for subcutaneous preparations will bedone using known methods to prepare such pharmaceutical compositions.

The above treatment regiments and dosages of cross-linked protein C orcross-linked activated protein C are non-limiting. A skilled artisan maydetermine the dosages based on a particular patient and a particulardisease. It is anticipated that treatment regimes of protein C oractivated protein C may be used as a guide, including treatment regimesknow or indicated for Xigris® (i.e. 24 mcg/kg/hr IV for 96 hrs), arecombinant activated protein C. However, it may be possible toadminister increased amounts of cross-linked protein C or cross-linkedactivated protein C due to reduced anti-coagulant activity and decreasedrisk of bleeding.

III. Therapeutic Applications of APC Disorders Caused by Inflammationand Apoptosis A. Sepsis

Activated protein C has been used for treatment of severe sepsis,including as described in U.S. Pat. No. 6,489,296, herein incorporatedby reference in its entirety. Sepsis is a systemic reactioncharacterized by arterial hypotension, metabolic acidosis, decreasedsystemic vascular resistance, tachypnea and organ dysfunction. Sepsiscan result from septicemia, including bacteremia, as well as toxemia,including endotoxemia. The term “bacteremia” includes occult bacteremiaobserved in young febrile children with no apparent foci of infection.The term “sepsis” also encompasses fungemia, viremia, and parasitemia.Thus, septicemia and septic shock (acute circulatory failure resultingfrom septicemia often associated with multiple organ failure and a highmortality rate) may be caused by a number of organisms. The criteria fordiagnosing an adult with sepsis do not apply to infants under one monthof age. In infants, only the presence of infection plus a“constellation” of signs and symptoms consistent with the systemicresponse to infection are required for diagnosis (Oski's Pediatrics,2006).

Sepsis is considered to be present if infection is suspected ordemonstrated and two or more of the following systemic inflammatoryresponse syndrome (SIRS) criteria are met: heart rate is greater than 90beats per minute; body temperature is less than 36° C. or greater than38° C.; respiratory rate is greater than 20 breaths per minute; or, onblood gas, a P_(a)CO₂ less than 32 mm Hg; white blood cell count is lessthan 4000 cells/mm³ or greater than 12000 cells/mm³, or greater than 10%band forms as an indication of immature white blood cells. Patients aredefined as having “severe sepsis” if they have sepsis plus signs ofsystemic hypoperfusion, either end organ dysfunction or a serum lactategreater then 4 mmol/dL.

Patients are defined as having septic shock if they have sepsis plushypotension after an appropriate fluid bolus (typically 20 ml/kg ofcrystalloid). To diagnose “septic shock”, sepsis must be present asdefined above, and the following two criteria must be met: evidence ofinfection, through a positive blood culture; and refractive hypotensionwhich is defined as hypotension despite adequate fluid resuscitation. Inadults it may be defined as a systolic blood pressure less than 90 mmHg,or a MAP less than 60 mmHg, or a reduction of 40 mmHg in the systolicblood pressure from baseline. In children it is BP less than 2 SD of thenormal blood pressure.

Successful treatment of sepsis, sever sepsis, or septic shock may bedetermined by a return toward normalcy of any of the symptoms used aboveto describe sepsis, sever sepsis, or septic shock and.a decrease inmortality. In addition to the treatment regiums described above (seesection IIIB), treatment of sepsis, sever sepsis or septic shock may betreated as described in U.S. Pat. No. 6,489,296 whereby cross-linked APCis substituted for wild type APC. For the reasons described in sectionIIB, cross-linked protein C or cross-linked activated protein may beadministered in a similar manner. Cross-linked protein C andcross-linked activated protein C may be administered in addition to orin combination with other known treatments, for example appropriatehydration and/or antimicrobials, such as antibiotics, antifungal,antiviral and antiparasitic agents.

B. Ischemic Stroke

Successful treatment of ischemic stroke, vascular occlusion may bedetermined by increase in reperfusion, or return of neurologicalfunction, including a decrease in disabilities or mortality. In additionto the methods of administration of cross-linked protein C orcross-linked activated protein C generally described above (see sectionIIIB), treatment of ischemic stroke, vascular occlusion, andthromboembolic disorders may also be treated, by way of non-limitingexample as in Example 7 (2.0 mg/kg slow iv bolus for 15 minuets), or, asdescribed in U.S. Pat. No. 6,037,322 and U.S. Pat. No. 6,268,337 and(i.e. 0.05 mg/kg/hr for a 96 hr), U.S. Pat. No. 5,084,274 (i.e. 0.2mg/kg/hr to 1.1 mg/kg/hr activated protein C alone or in combinationwith a thrombolytic agents) and European Patent Specification EP 0 318201 B1. Cross-linked protein C and cross-linked activated protein C maybe administered in addition to or in combination with other knowntreatments, for example appropriate hydration and antiplatelet therapyor tPA.

Other diseases or disorders which may be treated by cross-linked proteinC or cross-linked activated protein C include but are not limited to:inflammatory bowel disease, vasculitis, renal ischemia, and pancreatitis(i.e. 1 μg/kg/hr to about 50 μg/kg/hr activated protein C by continuousinfusion for about 1 to about 240 hours), as described in U.S. Pat. No.7,204,981 and herein incorporated by reference in its entirety. Alsoincluded are multiple sclerosis, Hashimoto's thyroiditis, GravesDisease, chronic hepatitis, systemic lupus erythematosus, Alzheimer'sdisease or Parkinson's disease, (i.e. subcutaneously at a dose of 0.5mg/day), as also described in U.S. Pat. No. 7,204,981. Also included areneuropathological disorders including but not limited to stroke,Alzheimer's disease, Huntington disease, multiple sclerosis (MS),ischemia, epilepsy, amyotrophic and lateral sclerosis as described inU.S. Pat. No. 7,074,402, and hereby incorporated by reference.Cross-linked protein C and cross-linked activated protein C may beadministered in addition to or in combination with other knowntreatments.

DEFINITIONS

The term “protein C” or “PC” refers to the inactive or zymogen form ofactivated protein C whether isolated from nature or produced throughrecombinant DNA methodology and includes all precursors, derivatives,variants, truncated variants, mutants, or analogs of PC which possess atleast one functional property associated with wild type protein C, orupon activation with wild type activated protein C. Also included inthis definition is the full length unmodified polypeptide of SEQ IDNO:1, and activated protein C. Non-limiting examples of protein Cderivatives are also described by Gerlitz et al., U.S. Pat. No.5,453,373, and Foster et al., U.S. Pat. No. 5,516,650, the entireteachings of which are hereby included by reference.

The term “activated protein C” or “APC” refers generally to theactivated form of protein C as defined in this section includingwild-type activated protein C whether isolated from nature or producedthrough recombinant DNA methodology.

The term “cross-linked” refers to the formation of a covalent chemicallinkage between two amino acid residues, or two polypeptide chains.Where those residues are cysteine cross-linked refers to the formationof a disulfide bond.

The term “cross-linked protein C” or “cross-linked PC” refers to proteinC that is the zymogen or precursor form of activated protein C whereinone or more of amino acid residues 261 to 266 of SEQ ID NO:1 (64-69chymotrypsin numbering (CHT)) have been cross-linked to one or more ofamino acid residues 278-288 of SEQ ID NO:1 (81-91 CHT) to stabilize ormodify biological properties. Cross-linked protein C as used hereinincludes all precursors, derivatives, variants, truncated variants,mutants, or analogs of PC, which contain the above, mentionedcross-linked amino acids.

The term “cross-linked activated protein C” or “cross-linked APC” refersto the activated form of cross-linked protein C as defined in thissection.

The term “Cys-67-82 protein C” or “Cys-67-82 PC” refers to oneembodiment of the instance invention whereby the inventors have replacedthe amino acid at position 67 (CHT) (264 of SEQ ID NO:1) with cysteine,and amino acid at position 82 (CHT) (279 of SEQ ID NO:1) with cysteine,of human protein C to allow formation of a disulfide bond, therebycross-linking two anti-parallel β-sheet polypeptide structures of thecomposition.

The term “Cys-67-82 activated protein C”, or “Cys-67-82 APC” or “mutantAPC” refers to the activated form of Cys-67-82 protein C, or Cys-67-82PC.

The term “activation” as used herein refers to the enzymatic cleavage ofthe protein C to release polypeptide residues 200-211 of SEQ ID NO:1.

Through out this disclosure the inventors refer to amino acid sequencesand specific amino acids using the “chymotrypsin numbering system” or“CHT.” This system was set forth by Bode et al., (Bode et al. (1989)EMBO J.; 8:3467-3475). Included in this disclosure is a human protein Camino acid sequence (Accession number NP_(—)000303) (SEQ ID NO:1). Byway of reference and example, Cys-67-82 corresponds to the substitutionof cysteine for amino acids 264 and 279 of SEQ ID NO:1 respectively,whereas the Ca²⁺ binding 70-80 loop corresponds to amino acids 267-277of SEQ ID NO:1.

The term “cytoprotective” refers to protection of cells in a patientfrom damage caused by conditions including but not limited toinflammation and apoptosis.

The term “anti-apoptotic” refers to protective effect whereby APCprevents or reduces the number of cells that will enter apoptosis orprogrammed cell death.

The term “in combination with” refers to the administration of acompound with cross-linked protein C or cross-linked activated proteinC, either simultaneously, sequentially, or a combination thereof.

Sequence identity or percent identity is intended to mean the percentageof same residues between two sequences. In sequence comparisons, the twosequences being compared are aligned using the Clustal method (Higginset al, Cabios 8:189-191, 1992) of multiple sequence alignment in theLasergene biocomputing software (DNASTAR, INC, Madison, Wis.). In thismethod, multiple alignments are carried out in a progressive manner, inwhich larger and larger alignment groups are assembled using similarityscores calculated from a series of pairwise alignments. Optimal sequencealignments are obtained by finding the maximum alignment score, which isthe average of all scores between the separate residues in thealignment, determined from a residue weight table representing theprobability of a given amino acid change occurring in two relatedproteins over a given evolutionary interval. Penalties for opening andlengthening gaps in the alignment contribute to the score. The defaultparameters used with this program are as follows: gap penalty formultiple alignment=10; gap length penalty for multiple alignment=10;k-tuple value in pairwise alignment=1; gap penalty in pairwisealignment=3; window value in pairwise alignment=5; diagonals saved inpairwise alignment=5. The residue weight table used for the alignmentprogram is PAM250 (Dayhoff et al., in Atlas of Protein Sequence andStructure, Dayhoff, Ed., NBRF, Washington, Vol. 5, suppl. 3, p. 345,1978).

Variations in the amino acid sequence will likely be comprised ofconservative amino acid substitutions, or substitutions of amino acidsoutside of functions regions such as the Gla region, the catalyticregion, or the activation peptide as described herein.

Preferred embodiments of the invention are described in the followingexamples. Other embodiments within the scope of the claims herein willbe apparent to one skilled in the art from consideration of thespecification or practice of the invention as disclosed herein. It isintended that the specification, together with the examples, beconsidered exemplary only, with the scope and spirit of the inventionbeing indicated by the claims, which follow the examples.

EXAMPLES

A novel protein C was created with a unique set of biologicalproperties. As will be shown, the unique properties include increasedactivation by free thrombin, with the resulting activated formdemonstrating greatly reduced anti-coagulation activity, with theanti-inflammatory, anti-apoptotic activity of the wild type molecules.The novel protein C includes a disulfide bond that has been engineeredto be located between two anti-parallel β-structures of protein C, thebond forms a cross-link and stabilizes the 70-80 Ca²⁺ binding loop.

Arginine at position 67 (Arg-67) and Aspartic acid at position 82(Asp-82) was replaced with cysteine to create a disulfide bond betweenthe respective polypeptide structures. As will be shown the cross-linkedprotein C can be activated by free thrombin 60-80 times more efficientlythan wild-type protein C. It was further observed that cross-linkedactivated protein C (Cys-67-82 APC) retained its anti-inflammatory andanti-apoptotic protective properties but demonstrated a loss ofanti-coagulant activity shown in both in vitro and in vivo assays. Itwas observed that the protective signaling effects of the cross-linkedAPC were slightly reduced (½) as determined in vitro by apoptosis,permeability, and leukocyte adhesion and migration assays in EA.hy926endothelial cells.

The engineered disulfide bond appears to stabilize the APC mutant in aconformation that is incapable of cleaving procoagulant cofactors, butcapable of interacting with the target cytoprotective endothelial cellsignaling molecules. Thus, this cross-linked APC may be a safer drug fortreating severe sepsis and other inflammatory or apoptotic disorders inpatients who are at higher risk of bleeding due to the anti-coagulantfunction of APC.

Reagents

Staurosporine was purchased from Calbiochem (San Diego, Calif.). Thefollowing antibodies were used for Western blots: polyclonal human AIF(1:1000), Bax (1:100, Chemicon, Temecula, Calif.), human p53 (1:1000,Cell Signaling, Beverly, Mass.), human Bcl-2 (1:100, Santa CruzBiologics, Santa Cruz, Calif.), and actin (1:5000, Sigma, St Louis,Mo.). Antibodies blocking activation of PAR-1 (H-111, Santa CruzBiologics, Santa Cruz, Calif.) or non-blocking (S-19, Santa CruzBiologics, Santa Cruz, Calif.) were used at 25 μg/ml. Function-blockingEPCR antibody (clone RCR-252; Cell Sciences, Canton, Mass.) was alsoused at 25 μg/ml. Tumor necrosis factor-α (TNF-α) was purchased from R&DSystem (Minneapolis, Minn.). Human plasma fVa, factor Xa andantithrombin were purchased from Haematologic Technologies Inc. (EssexJunction, Vt.), and Spectrozyme PCa was purchased from AmericanDiagnostica (Greenwich, Conn.).

Construction and Expression of Recombinant Proteins

The amino acid sequence for Protein C has previously been described(Beckmann et al. (1985) Nucleic Acids Res. vol. 13 pp. 5233-5247;Plutzky et al. (1986) PNAS Vol. 83, pp 546-550), and is represented bySEQ ID NO:1 (Accession number NP_(—)000303, NBCI). Elements of theinventors' methodology not described herein are generally well known anddetailed in numerous laboratory protocols, including Molecular Cloning2nd edition, (1989) Sambrook, J., Fritsch, E. F., and Maniatis, J., ColdSpring Harbor., and Current Protocols in Molecular Biology, volumes 1-3,John Wiley & Sons, Inc. herein incorporated by reference.

Wild-type protein C and the cross-linked protein C, (Cys-67-82 PC) (SEQID NO:2) were expressed in human embryonic kidney cells (HEK-293) byusing the RSV-PL4 expression system purification vector system asdescribed (Yang et al. (2006) Proc Natl Acad Sci. (USA); 103:879-884)and herein incorporated by reference. Two complementary sense 5′-AAG AAGCTC CTT GTC TGC CTT GGA GAG TAT GAC-3′ (SEQ ID NO:3) and antisense5′-GTC ATA CTC TCC AAG GCA GAC AAG GAG CTT CTT-3′ (SEQ ID NO:4)oligonucleotide PCR primers representing the three base codons for theamino acid residues 62-72 (chymotrypsin numbering) were synthesized inwhich the codon for Arg-67 (residue 264 of SEQ ID NO:1) was replacedwith the codon for cysteine in both primers (underlined). Moreover, twoadditional oligonucleotides 5′-GAG AAG TGG GAG CTG TGC CTG GAC ATC AAGGAG-3′ (SEQ ID NO:5) (sense) and 5′-CTC CTT GAT GTC CAG GCA CAG CTC CCACTT CTC-3′ (SEQ ID NO:6) (anti-sense) representing amino acid residues77-87 were synthesized in which the codon for the residue Asp-82(residue 279 of SEQ ID NO:1) was replaced with the codon representingcysteine in both primers (underlined) The protein C cDNA (SEQ ID NO:7)(Accession number NM_(—)000312) was amplified in two rounds toincorporate the desired mutations into the protein C sequence usingstandard PCR mutagenesis methods as previously described (Rezaie et al.(1992). Journal of Biological Chemistry, vol. 267, pp. 26104-26109) andherein incorporated by reference. The resulting mutant protein C cDNA(SEQ ID NO:8) was sub-cloned into HindIII and XbaI restriction enzymecloning sites of the commercially available expression vector pRc/RSV(Invitrogen, San Diego, Calif.) using standard cloning methods. Thisvector contains a G418 resistant gene for selection in mammalian cellsusing the aminoglycoside antibiotics Gentamycin (Calbiochem, San Diego,Calif.). The accuracy of the mutations in the expression vectorcontaining the mutant cDNA was confirmed by DNA sequencing and thenintroduced to human embryonic kidney (HEK) 293 cells for expression. Ahigh expressing stable G418 resistant clone was identified by a SandwichELISA using an anti-protein C polyclonal antibody and the HPC4monoclonal antibody, and expanded for production as described (Ref.Journal of Biological Chemistry, A. R. Rezaie and C. T. Esmon, vol. 267,pp. 26104-26109, 1992). The mutant protein (SEQ ID NO:2) was isolatedfrom 20-L cell culture supernatants by a combination of immunoaffinityand ion exchange chromatography using the HPC4 monoclonal antibody and aMono Q ion exchange column (Amersham Pharmacia).

Statistical Analysis

Results are expressed as mean±SEM, and t-Tests (paired or independent)were used to assess data. Differences were considered statisticallysignificant at p values of <0.05. Statistics were performed using thesoftware package SPSS version 14.0 (SPSS, Chicago, Ill.).

Example 1 Protein C Activation by Thrombin

Protein C exists in the form of a zymogen and requires activation toexert its cytoprotective and anti-coagulant properties. Thrombin is avery poor activator of protein C in the absence of thrombomodulin (TM)(Esmon C T. (1993) Thromb. Haemost. 70:1-5). Activation of wild-type andcross-linked protein C (Cys-67-82) was compared to determine if the rateactivation by free thrombin was increased.

The initial rate of protein C activation by thrombin was measured in 0.1M NaCl, 0.02 M Tris-HCl, pH 7.4 (TBS) containing 1 mg/mL bovine serumalbumin (BSA), 0.1% polyethylene glycol (PEG) 8000 and 2.5 mM Ca²⁺(TBS/Ca2+) in 96-well assay, plates as described (Yang et al. (2006)Proc Natl Acad Sci. (USA); 103:879-884) and herein incorporated byreference. At different time intervals, thrombin activity was quenchedby 500 nM AT in complex with 1 μM heparin. The activation rate wasmeasured by an amidolytic activity assay using Spectrozyme PCa, and asdescribed (Yang et al. (2006) Proc Natl Acad Sci. (USA); 103:879-884),the cleavage rate of 200 μM Spectrozyme PCa (American Diagnostica) wasmeasured at 405 nm by a Vmax Kinetic Microplate Reader (MolecularDevices). The concentration of APC in the reaction mixture wasdetermined by reference to a standard curve that was prepared by totalactivation of the zymogen with excess thrombin at the time of theexperiments. All reactions were carried out at room temperature, and itwas ensured that less than 10% substrate was used in all activationreactions.

The initial rate of wild-type and mutant protein C activation bythrombin in the absence of TM and in the presence of physiologicalconcentrations of Ca²⁺ is presented in FIG. 2. Comparisons of theactivation these rates suggest that, relative to wild-type, theactivation of Cys-67-82 protein C by thrombin was improved 60-80-foldindependent of TM.

The Ca²⁺-dependence of protein C activation by thrombin revealed thatthe 70-80 loop of the mutant did not bind Ca²⁺ (data not shown).

A benefit of this increased level of activation by thrombin is thatcross-linked protein C may be more effective than wild-type protein C orother variants. When administered as a zymogen, cross-linked protein Cwill be activated on demand by endogenous free thrombin. This isparticularly beneficial during inflammation conditions where TM on theendothelial cell surface is down regulated and less readily available.Under these conditions, wild-type or other variants will be activatedless efficiently, and also will posses anti-coagulant properties thatwill increase the risk of severe bleeding.

Example 2 Anti-Coagulant Activity

The anti-coagulant activity of wild-type and Cys-67-82 APC was examinedin purified and plasma-based clotting assays. In the purified system,APC concentration dependence of fVa inactivation was measured by aprothrombinase assay from a decrease in the fVa-catalyzed prothrombinactivation as described (Yang et al. (2005) Thromb Haemostas.;94:60-68). Essentially, fVa (5 nM) was incubated with wild-type ormutant APC (1 nM) on 25 μM PC/PS vesicles in TBS containing 2.5 mM Ca2+,0.5 mg/ml BSA and 0.1% PEG 8000. In the second stage, at different timeintervals (0-40 min), the remaining fVa activity was determined in aprothrombinase assay from the fVa-catalyzed prothrombin activation byfXa. The prothrombinase assay was carried out for 30 sec with excessprothrombin (1 μM) and a saturating fXa (10 nM) at room temperature. Theremaining activity of fVa was determined from the decreased rate ofthrombin generation as monitored by an amidolytic activity assay in thethird stage using 100 μM S2238.

The anti-coagulant activities in plasma were evaluated in an activatedpartial thromboplastin time (APTT) assay using a STart 4 fibrinometer(Diagnostica/Stago, Asnieres, France) as described (Yang et al. (2005)Thromb Haemostas.; 94:60-68). Briefly, 0.05 ml TBS lacking or containing1-20 nM final concentrations of wild-type or mutant APC was incubatedwith a mixture of 0.05 ml normal pooled plasma plus 0.05 ml APTT reagent(Alexin) for 5 min before the initiation of clotting by the addition of0.05 ml of 35 mM CaCl₂ at 37° C.

As presented in FIG. 3A, Cys-67-82 APC exhibited dramatically impairedactivity in a fVa degradation assay monitoring the inhibition ofthrombin generation by prothrombinase. Similarly, in the APTT initiatedclotting assay, the APC mutant did not exhibit any anti-coagulantactivity for up to 10 nM protease and doubling the concentration of themutant minimally improved the specific activity of the protease in theclotting assay (FIG. 3B). The lack of anti-coagulant activity for thecross-linked APC was not due to its enhanced reactivity with plasmaserpins, as evidenced by a normal inhibition profile for the mutant withanti-thrombin, α1-antitrypsin and protein C inhibitor (data not shown).This was confirmed by direct monitoring of the time course of theamidolytic activity of wild-type and mutant APC following incubationwith normal plasma (data not shown). Therefore, it was demonstrated thatCys-67-82 APC did not readily prevent clot formation. This wouldindicate that unlike wild type APC, the risk of enhanced bleeding wouldnot occur with administration of Cys-67-82 APC.

Example 3 Effect of APC on Thrombin-Induced Permeability

It is known that thrombin disrupts the permeability barrier ofendothelial cells, thereby further propagating the inflammatoryresponse. It is also known that APC provides potent protection againstthese effects (Feistritzer et al. (2005) Blood.; 105:3178-3184). Todetermine whether Cys-67-82 APC retained this protective property, anassay was designed to compare the protective effect of Cys-67-82 APCwith that of the wild-type APC.

Permeability was quantitated by spectrophotometric measurement of theflux of Evans blue-bound albumin across functional EA.hy926 cellmonolayers using a modified 2-compartment chamber model as previouslydescribed (Feistritzer et al. (2005) Blood.; 105:3178-3184). Briefly,EA.hy926 cells were plated (5×10⁴/well) in transwell of 3 μm pore sizeand 12-mm diameter for 4-6 days. The confluent monolayers were incubatedwith APC (20 nM) for 3 h followed by activation by thrombin (5 nM) for10 min as described (Feistritzer et al. (2005) Blood.; 105:3178-3184).Inserts were washed with PBS, pH 7.4 before adding 0.5 mL Evans blue(0.67 mg/mL) (Sigma, St Louis, Mo.) diluted in growth medium containing4% BSA. Fresh growth medium was added to the lower chamber, and themedium in the upper chamber was replaced with Evans blue/BSA. After 10min the optical density at 650 nm was measured in the lower chamber. Forthe function-blocking antibody treatments of the monolayers, medium wasremoved and antibodies were added for 30 min in serum-free mediumfollowed by analysis of the permeability. Experiments were performed intriplicate and repeated multiple times.

As shown in FIG. 4, treatment of EA.hy926 cells with thrombin resultedin an enhanced permeability that was effectively reversed by bothwild-type and Cys-67-82 APC. In agreement with published data for APC,(Feistritzer et al. (2005) Blood.; 105:3178-3184) the protective effectof the APC mutant required the interaction of the protease with bothEPCR and PAR-1. This was demonstrated using function-blocking antibodiesto either EPCR or PAR-1 (H-111). When these antibodies were included,the protective effects of both wild-type and Cys-67-82 APC wereeliminated (FIG. 4B). S-19 is a non-function-blocking antibody againstPAR-1, which was used as a control. These results indicate thatCys-67-82 APC has retained this protective property and functionedthrough the same signaling pathways. Comparisons of concentrationdependence of the cytoprotective activity of wild-type and mutant APCsuggested that, slightly more, 10 nM cross-linked APC compared to 5 nMwild-type APC, was required to obtain a maximal cytoprotective effect(data not shown).

Example 4 Anti-Apoptotic Activity of APC

The anti-apoptotic effects of Cys-67-82 APC were demonstrated inendothelial cells under conditions known to induce apoptosis.

Apoptotic effects were determined by measuring known apoptoticindicators, Bcl-2 p53, Bax and AIF genes, and Terminal deoxynucleotidylTransferase Biotin-dUTP Nick End Labeling (TUNEL). The transformed humanendothelial cell line EA.hy926 were cultured to confluence in ahumidified atmosphere at 37° C. in Dulbecco modified eagle medium(Invitrogen, Carlsbad, Calif.) supplemented with 10% fetal bovine serum(HyClone, Logan, Utah) and antibiotics (penicillin G and streptomycin).EA.hy926 cells (0.5×106) were seeded onto coverslips coated with gelatinas described. (Mosnier et al. (2003) Biochem J.; 373:65-70). After 24 hat 37° C., the medium was replaced and cells were incubated with proteinC or APC (10 nM) for another 24 h. Then, the cells were incubated with 5μM staurosporine for 4 h. The cells were fixed with 3% paraformaldehyde,permeabilized with 0.1% Triton X-100, 0.1% sodium citrate, and incubatedfor one h at 37° C. in the dark with a TUNEL reaction mixture (Roche,Germany) for in situ detection of cell death. After twice washing withPBS pH 7.4, the cells were incubated with the Hoechst 33342 (Sigma, StLouis, Mo.) for 15 min. The number of apoptotic cells was expressed asthe percentage of TUNEL-positive cells of the total number of nucleidetermined by Hoechst staining.

Previous results have demonstrated that APC exhibits cytoprotectiveactivity in a staurosporine-induced apoptosis assay (Mosnier et al.(2003) Biochem J.; 373:65-70). As shown in FIG. 5, the APC mutantexhibited normal anti-apoptotic activity in EA.hy926 cells treated withstaurosporine. The cytoprotective activity of both APC derivatives weremediated, at least partially, through inhibition of the caspase-3activity and the function-blocking antibodies to either EPCR or PAR-1abrogated the anti-apoptotic activity of both APC derivatives (data notshown). The cytoprotective activity of APC required an intactactive-site and was mediated through the up-regulation of Bcl-2 and thedown-regulation of p53, Bax and AIF genes (FIG. 5C) as previouslydemonstrated. (Oren M. (1999) J Biol Chem.; 274:36031-36034; Cheng etal. (2003) Nature Med.; 9:338-342; Guo et al. (2004) Neuron.;41:563-572). These studies were extended to examine whether APC can alsoinhibit apoptosis in TNF-α-treated EA.hy926 cells. As shown in FIG. 6,TNF-α treatment of confluent endothelial cells induced an apoptoticpathway that was detected by a TUNEL assay. The pretreatment ofendothelial cells with 10 nM of either wild-type or mutant APC potentlyinhibited cell death induced by TNF-α (FIG. 6B). Therefore, it wasdemonstrated that Cys-67-82 APC possessed anti-apoptotic properties.

Example 5 Effect of APC on TNF-α-Mediated Leukocyte Adhesion andMigration

To further understand the anti-inflammatory and anti-apoptoticproperties of Cys-67-82 APC, expression of cell adhesion molecules(CAM), as well as the adherence and migration of neutrophils onendothelial cells was examined.

Neutrophil adherence to endothelial cells was evaluated by fluorescentlabeling of neutrophils according to the methods of Akeson and Woods asdescribed (Akeson et al. (1993) J Immunol Methods.; 163:181-185; Kim etal. (2001) J Biol Chem.; 276:7614-7620). Briefly, peripheral bloodneutrophils were labeled with 5 μM Vybrant DiD (Molecular Probes) for 20min at 37° C. in phenol red-free RPMI containing 5% fetal bovine serum.Following twice washing of neutrophils (1.5×10⁶/ml, 200 μl/well), theywere resuspended in adhesion medium (RPMI containing 2% fetal bovineserum and 20 mM HEPES) and added to confluent monolayers of EA.hy926cells in 96-well plates which were treated with APC derivatives (20 nMfor 24 h) followed by activation by TNF-α (10 ng/mL) for 4 h. Thefluorescence of labeled cells was measured (total signal) using afluorescence microplate reader (Molecular Device). After incubation for60 min at 37° C., non-adherent cells were removed by washing four timeswith pre-warmed RPMI and the fluorescent signals of adherent cells weremeasured by the same methods. The percentage of adherent leukocytes wascalculated by the formula: % adherence=(adherent signal/totalsignal)×100.

The expression of vascular cell adhesion molecule 1 (VCAM-1),intercellular adhesion molecule 1 (ICAM-1) and E-selectin on EA.hy926cells was determined by a whole-cell ELISA. Briefly, confluentmonolayers of EA.hy926 cells were treated with APC derivatives (20 nM)for 24 h followed by TNF-α for 4 h. The medium was removed; cells werewashed with PBS, and fixed by adding 50 μL of 1% paraformaldehyde for 15minutes at room temperature. After washing, 100 μL of mouse anti-humanmonoclonal antibodies (VCAM-1, ICAM-1, E-selectin, Temecula, Calif.,1:50 each) were added. After 1 h (37° C., 5% CO2), the cells were washedthree times and then 100 μL of 1:2000 peroxidase-conjugated anti-mouseIgG antibodies (Sigma, Saint Louis, Mo.) was added for 1 h. The cellswere washed again three times and developed using o-phenylenediamenesubstrate (Sigma, Saint Louis, Mo.). Colorimetric analysis was performedby measuring absorbance at 490 nm. All measurements were performed intriplicate wells.

Migration assays were performed in transwell plates of 6.5 mm diameter,with 8 μm pore size filters. EA.hy926 cells (6×10⁴) were cultured forthree days to obtain confluent endothelial monolayers. Before addingneutrophils to the upper compartment, the cell monolayers were washedthree times with PBS, and freshly isolated neutrophils (1.5×10⁶/0.2 mL)were added to the upper compartment. In blocking experiments, theEA.hy926 cells were preincubated for 30 min at 37° C. with indicatedantibodies. Transwell plates were incubated at 37° C., 5% CO₂ for 2 h.Cells in the upper chamber of the filter were aspirated andnon-migrating cells on top of the filter were removed with a cottonswab. Neutrophils on the lower side of the filter were fixed with 8%glutaraldehyde and stained with 0.25% crystal violet (Sigma, St Louis,Mo.) in 20% methanol (w/v). Each experiment was repeated in duplicatewells and within each well counting was done in nine randomly selectedmicroscopic high power fields.

The TNF-α treatment of HUVECs is associated with the up-regulation ofseveral cell surface adhesion molecules such as VCAM-1, ICAM-1 andE-selectin and APC has been demonstrated to inhibit the expression ofthese molecules. (Joyce et al. (2001) J Biol Chem.; 276:11199-11203).The results presented in FIG. 7A support these findings in EA.hy926cells and further demonstrate that APC suppression of the TNF-α-mediatedexpression of adhesion molecules is EPCR and PAR-1-dependent asevidenced by the ability of the function-blocking antibodies to eitherreceptor to neutralize the modulatory effect of APC. Similar towild-type, the APC mutant down-regulated the TNF-α-mediated expressionof all three adhesion molecules in EA.hy926 cells (FIG. 7A). Furtherstudies were initiated to determine whether the expression of theseadhesion molecules correlates with enhanced binding of neutrophils andif APC can block the adhesion of neutrophils to TNF-α-activated EA.hy926cells. The results presented in FIG. 7B demonstrate that both APCderivatives effectively inhibited the binding of neutrophils to theTNF-α-activated endothelial cells by EPCR and PAR-1-dependent pathways.Further studies revealed that the adhesion of neutrophils to endothelialcells is associated with their subsequent transendothelial migration andthat both APC derivatives inhibit this step by a similar EPCR andPAR-1-dependent mechanism (FIG. 7C). Moreover, the inhibition ofneutrophil transendothelial migration required proteolytic events by APCsince neither protein C nor S195A PC exhibited any inhibitory property(data not shown). Therefore Cys-67-82 APC will inhibit the binding ofneutrophils to endothelial cells under conditions that induceinflammation or apoptosis.

Taken together, Examples 1-5 clearly demonstrate that, unlike the nearcomplete loss of the anti-coagulant activity, the in vitro indices ofthe anti-inflammatory and cytoprotective activities of the APC mutanthave remained intact including the endothelial protein C receptor(EPCR), and protease-activated receptor-1 (PAR-1) dependent signalingproperties. These results indicate that the modulation of the structureand/or activity of the catalytic domain of the APC 70-80 loop may berequired for its anti-coagulant, but not for its anti-apoptoticproperties. The anti-coagulant function of APC may require the cofactorfunctions of the metal ions Ca²⁺ and Na⁺ both of which allostericallymodulate the structure and catalytic function of APC (He et al. (1999) JBiol Chem.; 274:4970-4976). Such a coordinated metal ion modulation ofthe APC structure and function has been disrupted in cross-linked APCsince the engineered disulfide bond may abolishes the requirement forCa²⁺ and may stabilizes the Na⁺ binding site of the mutant protease inthe high affinity state. These structural changes may be important forthe anti-coagulant function but not for the protective signaling effectsof APC.

For APC to elicit protective signaling responses, it must remainassociated with EPCR on the surface of endothelial cells. The exactmechanism through which APC exerts its cell signaling effects is notknown. In vitro and in vivo studies have demonstrated that, in additionto binding EPCR, the protective signaling effect of APC also requiresthe presence of PAR-1 on the surface of endothelial cells (Feistritzeret al. (2005) Blood.; 105:3178-3184; Cheng et al. (2003) Nature Med.;9:338-342).

Studies have indicated that the EPCR-dependent cleavage of PAR-1 atArg-41, the same recognition site on the receptor for thrombin (CoughlinSR. (1994) Trends Cardiovasc Med.; 4:77-83), is responsible for thedirect cell signaling effect of APC (Mosnier et al. (2004) Blood.104:1740-1744). Studies have also shown that APC down-regulatesexpression of several key pro-inflammatory cytokines (i.e., TNF-α andIL-1), adhesion molecules (i.e., ICAM-1 and VCAM-1), and transcriptionfactors (i.e., nuclear factor-kB related molecules) in human endothelialand non-endothelial cells (9).

Cross-linked APC retains these anti-inflammatory and anti-apoptoticproperties. Both wild-type and cross-linked APC inhibited theTNF-α-mediated up-regulation of ICAM-1, VCAM-1, and E-selectin.Typically, during an inflammatory response the expression of theseadhesion molecules is up regulated. Leukocytes undergo extravasation bybinding to these molecules on the surface of endothelial cells (Kim etal. (2001) J Biol Chem.; 276:7614-7620). As disclosed herein, it wasdemonstrated that the enhanced TNF-α-mediated expression of theseadhesion molecules on transformed endothelial cells is associated withincreased binding of neutrophils and their subsequent transendothelialmigration. Cross-linked APC has effectively inhibited these processesthrough EPCR and PAR-1-dependent mechanisms.

Increased vascular permeability is another hallmark of inflammatorydisorder, and has been observed during sepsis (Finigan et al. (2005) JBiol Chem.; 280:17286-17293). In vitro studies have shown that APCreverses thrombin-induced endothelial permeability. This effect isresponsible for enhancing the anti-inflammatory properties of APC andimproving survival in severely septic patients (Finigan et al. (2005) JBiol Chem.; 280:17286-17293; Feistritzer et al. (2005) Blood.;105:3178-3184). Cross-linked APC exhibits normal protective endothelialbarrier properties via EPCR and PAR-1-dependent mechanisms. Also, asdemonstrated using a staurosporine-induced apoptosis assay, thecytoprotective properties of the cross-linked APC are normal andmediated through the inhibition of caspase 3, up-regulation of Bcl-2,and down-regulation of p53, Bax, and AIF genes as previously shown forwild-type APC. (Mosnier et al. (2004) Blood. 104:1740-1744; 29, 30)Using this assay, it was demonstrated that cross-linked APC functionedby similar EPCR and PAR-1-dependent mechanisms. In addition, theanti-apoptotic activity of cross-linked APC using the pro-inflammatorycytokine TNF-α to induce apoptosis in endothelial cells was alsoevaluated. It was found that similar to wild-type, cross-linked APCpotently inhibited cell death induced by the physiological cytokineTNF-α.

Example 6 Anti-Coagulant Activity of Cys-67-82 APC in Baboon and MousePlasma

In preparation for studies in vivo, the inventors investigated theeffects of Cys-67-82 APC on coagulation time in baboon and mouse plasmain vitro. The methodology used is described in Example 2 for humanplasma. Compared to WT APC, Cys-67-82 APC demonstrated greatly reducedanti-coagulant activity in both baboon and mouse plasma, in the APTTtests (Cys APC, FIG. 8). These results were similar to those obtainedusing pooled human plasma (see Example 2). Similarity anticoagulantproperties between species, suggested that the baboon and mouse modelswould also be suitable to demonstrate the protective behaviors ofCys-67-82 APC in vivo.

Example 7 Anti-Thrombotic and Anti-Hemostatic Activities of Cys-67-82APC in Primates

Experiments were designed to determine whether Cys-67-82 APC exhibitsanti-thrombotic and anti-hemostatic effects in a primate model ofhemostasis. All experiments were performed using trained consciousbaboons with surgically implanted chronic arteriovenous shunts,essentially as described (Hanson 1993, Gruber 2007). In brief, athrombogenic device consisting of a 20 mm long knitted polyethyleneterephthalate (Dacron) graft segment (4 mm ID) and a 20 mm long siliconerubber thrombus chamber (9 mm ID) was deployed into the shunt at 0 minand perfused for one hour at a controlled blood flow rate of 100 mL/min.Fibrin deposition in the thrombogenic device, template bleeding times,and systemic APTT values were monitored. For the initial experiments,the inventors chose to compare the anti-thrombotic and anti-hemostaticeffects of equal doses of WT and Cys-67-82 APC. Vehicle (N=6), WTAPC(N=4), or Cys-67-82 APC(N=3) were administered as a loading bolus (75μg/kg) at 0 min (start of experiment, immediately after deployment ofthe thrombogenic graft) followed by continuous infusion at a rate of 150μg/kg/h. The results of the measurements were averaged but statisticswere not provided due to the low number of experiments.

This model has been shown to be sensitive to numerous anti-thromboticagents, including fibrinolytic agents, anti-coagulants, and antiplateletagents. End-point fibrin deposition in the thrombus chamber averaged 2.1mg in controls, 2 mg after Cys-67-82 APC administration and 1 mg afterWT APC treatment, indicating that the mutant APC demonstrated a reducedanti-thrombotic effect. Cys-67-82 APC also did not seem to have aprofound affect on two hemostatic parameters, APTT and template bleedingtime (Table 1).

TABLE 1 Hemostatic parameters in baboons during treatment with Cys-67-82APC (CysAPC). Bleeding time Bleeding time Bleeding time Sampling APTT,sec APTT, sec prolongation prolongation prolongation time CysAPC WT APCvehicle WT APC CysAPC  0 min 34.4 26.4 10 min 34.6 68.8 40 min 34.6 57.31.1-fold 1.5-fold 1.2-fold 70 min 34.4 57.1

These results indicate that Cys-67-82 APC has reduced anti-coagulanteffects in vivo compared to wild-type APC. In particular end-pointfibrin deposition was increased compared to wild-type APC indicatingreduced anti-coagulant activity.

Example 8 Neuroprotective Activities of Cys-67-82 APC in Mice

To examine the neuroprotective effects of Cys-67-82 APC on ischemiastroke, a mouse middle cerebral artery occlusion (MCAO) and reperfusionmodel was used. A mouse middle cerebral artery occlusion (MCAO) andreperfusion model was used essentially as described (Clark 1977), andmodified (Choudri 1998, 1999, Shibata 2001). Isoflurane anesthesia wasused during all invasive procedures. The femoral vein was asepticallyisolated and soaked with sterile saline. A transcranial laser Dopplerflow probe was secured in over the parietal lobe for blood flowmonitoring of the cerebral cortex. Stroke was initiated in the righthemisphere by the MCAO procedure. Arterial stenosis, blood vesselinjury, and secondary local activation of the coagulation cascade wereinitiated by temporary surgical deployment of a foreign body (6-0 nylonfilament) into the middle cerebral artery (MCA) for 60 min. Thebeginning of cerebral ischemia was arbitrarily defined as decrease inblood flow over the parietal cortex below 20% of the pre-MCAO baseline.The intraluminal filament restricted blood flow to the ipsilateralhemisphere, initiated progressive thrombosis, and caused ischemic strokein the MCA region. Treatments (see Table 2) were administered into thefemoral vein while the filament was in the MCA. Infusion of the testagents started at 15 min from the beginning of cortical ischemia.

Measurements of cerebral infarction volumes were determined as follows.After 24 h, animals were killed and their brains rapidly harvested.Infarct volumes were determined by staining serial cerebral sectionswith triphenyltetrazolium chloride (TTC) and performing computer-basedplanimetry of the negatively stained areas to calculate infarct volumes(using National Institutes of Health image software).

Neurological exams were determined as follows. Before administeringanesthesia, mice were examined for neurological deficits 23 h afterreperfusion. Neurological scores were determined using a four-tieredgrading system: a score of 1 was given if the animal demonstrated normalspontaneous movements; a score of 2 was given if the animal was noted tobe turning towards the ipsilateral side; a score of 3 was given if theanimal was observed to spin longitudinally (clockwise when viewed fromthe tail); and a score of 4 was given if the animal was unresponsive tonoxious stimuli.

This model has been shown to be sensitive to all tested anti-thrombotictreatments, including high doses of APC and tPA (Shibata et al. (2001)Circulation. 103(13):1799-805; Fernandez et al. (2003) Blood Cells MolDis. (3):271-6; Kilic et al. (1999) Neuroreport, 10(1):107-11).Anti-thrombotic interventions reduce infarct size, improve neurologicaloutcome, and improve blood flow recovery (reperfusion) in the affectedbrain region. This is a complex model that involves numerous connectedevents, and accordingly it is also sensitive and responsive to variousother non-causal interventions, including, among others, the use ofanti-apoptotic agents, temperature control, or post-ischemic care(McCullough et al. (2003) J Neurosci; 23(25):8701-5; Barber, et al.(2004) Stroke. 35(7):1720-5. Epub; DeVries et al. (2001) Proc Natl AcadSci USA. 98(20):11824-8. Epub). The apparent neuroprotective effect ofhigh dose WT human and mouse APC might be closely related to thecatalytic activation of PAR1 and 3 (Guo et al. (2004) Neuron.;41(4):563-72; Domotor et al. (2003) Blood.; 101(12):4797-801. Epub;Cheng, et al. (2003) Nat Med. 9(3):338-42. Epub), and protection of theneurovascular unit from ischemia and/or reperfusion injury.

Preliminary experiments were performed to investigate whether Cys-67-82APC had a potential to improve the outcome of ATIS in this model. Sinceex vivo data suggest that the neuroprotective activity is not impairedby Cys-67-82 APC, we hypothesized that Cys-67-82 APC treatment of ATISin mice could produce measurable benefits due to its potentialcytoprotective effect. Cys-67-82 APC may offer an alternative to thetreatment of stroke with WT APC or tPA, both of which can cause bleedingin human patients. WT APC has not yet been evaluated in stroke, likelybecause it impairs hemostasis and therefore would not be useful for thetreatment of human ATIS. tPA has been approved for the treatment ofstroke but it has severe bleeding side effects, thus its use is severelylimited. A safe but equally effective neuroprotective agent, such asCys-67-82 APC, could be effective in stroke without the danger ofincreasing intracerebral hemorrhage (ICH).

Negative controls included no treatment and vehicle treatment. Positivecontrols included two groups of tPA treatments. Three types of APCtreatments were evaluated: WT APC, Cys-67-82 APC, and the protein Cactivator (PCA) double mutant thrombin W215A/E217A which activatesendogenous protein C. Each agent was administered at a single dose levelbetween 15 and 60 min of MCAO. The foreign body (filament) was removedfrom the MCA after 60 min. 30 min later (at 90 min) the LDF probe wasremoved, anesthesia was terminated, and the animals were observed forone day, when their performance was evaluated. (Table 2).

TABLE 2 Effect of tPA and APC treatments on various outcome parametersof acute thrombotic ischemic stroke in mice. N Hemorrhage Neuroscore;Reperfusion animals that Mortality macroscopic Infarct % Edemaperformance % blood flow survived between evidence of ipsilateral %ipsilateral score at recovery 15 Dose and surgery 2 and 24 hoursbleeding hemisphere hemisphere sacrifice, min after TreatmentAdministration and MCAO after MCAO on autopsy mean mean ± SEM mean MCAOmean None — 10 3/13. 0/13 60.0 ± 6.8 11.4 ± 1.2 3.5 ND Vehicle Vehicle10 2/12. 0/12.   58 ± 5.6   9 ± 1.9 4 47 ± 3 (saline), slow iv bolus at15 min, 100 μL Protein C activator 25 μg/kg; 5 10 4/14. 2/14. 22.1 ± 6.1 7.8 ± 1.4 1.5 76 ± 4 (PCA; recombinant min iv bolus human W215A/ at 15min, E217A; WE) 100 μL Plasminogen 2.5 mg/kg; 5 10 6/16. 7/16. 33.0 ±10.7  5.8 ± 3.2 3 78 ± 4 activator min iv bolus (PA; recombinant at 15min post human tissue- MCAO, 65 μL type PA; tPA) Plasminogen 10mg/kg/hr; 45 10 3/13. 4/13. 15.9 ± 4.9  6.7 ± 1.1 2 81 ± 6 activator mininfusion 15 (recombinant to 60 min during human tPA) MCAO, 185 μLActivated 2.0 mg/kg  5 3/8 2/9 13.6 ± 7.1  6.1 ± 2.5 2.5 78 ± 8 ProteinC slow iv bolus (human, plasma- at 15 min, derived) 100 μL Cys-CysActivated 2.0 mg/kg  5 1/6 2/6 26.1 ± 5.3  5.9 ± 1.3 2.7 69 ± 7 ProteinC slow iv bolus (recombinant at 15 min, human Arg67Cys/ 100 μL Asp82CysAPC)

The animals were sacrificed after neurological evaluation by removal oftheir blood and perfusion of the circulation with heparinized salinethrough cardiac puncture (left ventricle) under anesthesia. The brainwas cut into coronal sections, visually inspected for hemorrhage (i.e.,residual blood in the cranium after saline perfusion), stained with 2%triphenyl-tetrazolium chlorate (TTC) and the infarct volumes determined.Other areas, including the surgical sites were also evaluated forhemorrhage.

The data indicates that Cys-67-82 APC treatment during focal cerebralischemia improved the short term (24 h) neurological outcome of ATIS inmice. Most dramatic is a reduction on mortality (⅙), which wasequivalent to mice that received control vehicle alone. Cys-67-82 APCscored higher than any positive controls except plasminogen activator inthe neurological performance test. Surrogate markers of stroke, such asinfarct volume, seemed to be consistent with the neurological findings.Overall, Cys-67-82 APC had beneficial effects in this model similar toother forms of APC treatment, and as in comparison to tPA, which is thecurrent treatment of choice in humans.

All publications and patents cited in this specification are herebyincorporated by reference in their entirety. The discussion of thereferences herein is intended merely to summarize the assertions made bythe authors and no admission is made that any reference constitutesprior art. Applicants reserve the right to challenge the accuracy andpertinence of the cited references.

1. A method for treating inflammation or apoptosis in a human patientcomprised of administrated cross-linked protein C in an injectablephysiological solution parenterally.
 2. The method of claim 1 wherebythe cross-linked protein C is administered by intravenous injection. 3.The method of claim 1 whereby the cross-linked protein C is administeredby continuous infusion from about 0.01 μg/kg/hr to about 500 μg/kg/hrfor about 1 to about 240 hours.
 4. The method of claim 1 whereby thecross-linked protein C is administered such that plasma ranges are fromabout 2 ng/ml to about 1000 ng/ml.
 5. The method of claim 1 whereby theinflammation is associated with disease selected from the groupconsisting of sepsis, severe sepsis, and septic shock.
 6. The method ofclaim 1 whereby the inflammation is associated with disease selectedfrom the group consisting of inflammatory bowel disease, vasculitis,renal ischemia, and pancreatitis.
 7. The method of claim 1 wherebyinflammation or apoptosis is associated with a neurological diseaseselected from the group consisting of ischemic stroke, Alzheimer'sdisease, Huntington disease, multiple sclerosis, ischemia, epilepsy,amyotrophic and lateral sclerosis.
 8. A method for treating inflammationor apoptosis in a human patient comprised of administrated cross-linkedactivated protein C in an injectable physiological solutionparenterally.
 9. The method of claim 8 whereby the cross-linkedactivated protein C is administered by continuous infusion may be fromabout 0.01 μg/kg/hr to about 50 μg/kg/hr for about 1 to about 240 hours.10. The method of claim 8 whereby the cross-linked activated protein Cis administered such that plasma ranges are from about 2 ng/ml to about100 ng/ml.
 11. The method of claim 8 whereby the inflammation isassociated with disease selected from the group consisting of sepsis,severe sepsis, and septic shock.
 12. The method of claim 8 whereby theinflammation is associated with disease selected from the groupconsisting of inflammatory bowel disease, vasculitis, renal ischemia,and pancreatitis.
 13. The method of claim 8 whereby inflammation orapoptosis is associated with a neurological disease selected from thegroup consisting of ischemic stroke, Alzheimer's disease, Huntingtondisease, multiple sclerosis, ischemia, epilepsy, amyotrophic and lateralsclerosis.
 14. A method for treating ischemic stroke in a humancomprised of administering cross-linked activated protein C in aninjectable physiological solution parenterally.
 15. The method of claim14 whereby the cross-linked activated protein C is administered bycontinuous infusion may be from about 0.01 μg/kg/hr to about 50 μg/kg/hrfor about 1 to about 240 hours.
 16. The method of claim 14 whereby thecross-linked activated protein C is administered such that plasma rangesare from about 2 ng/ml to about 100 ng/ml.
 17. The method of claim 14whereby the cross-linked activated protein C is administered at about 2milligrams per kilogram intravenously.
 18. The method of claim 14whereby the cross-linked activated protein C is administered after astroke.